Insurance

Question 1

Heath insurance

Answer 1

Policies that can be purchased to cover health related services and goods

Question 2

Insured

Answer 2

Covered by policy

Question 3

Subscriber

Answer 3

Who purchased the policy

Question 4

Insurer

Answer 4

Health insurance company

Question 5

Covered services

Answer 5

Services covered by the policy

Question 6

Durable medical equipment (DME)

Answer 6

Medical equipment prescribed for the subscriber
Need for health insurance developed when hospitals became the main providers for critical care

Question 7

First party system

Answer 7

Individual seeking health care pays second party

Question 8

Third party system

Answer 8

Insurance helps pay for care

Question 9

Capitation

Answer 9

Payment system where provider is paid monthly

Question 10

Fee - for service

Answer 10

Payment for specific services only a percentage is paid

Question 11

Premium

Answer 11

Cost of policy

Question 12

Deductible

Answer 12

Amount subscriber pays before insurance helps pay

Question 13

Co payments

Answer 13

Flat amount subscriber pays for each visit

Question 14

Coinsurence

Answer 14

Percentage that subscriber pays for large services usually 20%

Question 15

Utilization review (ur)

Answer 15

Evaluation of services to ensure they are necessary, appropriate, and efficient

Question 16

Case management

Answer 16

Coordination of services to control costs and utilization

Question 17

Consumer- driven health care planes

Answer 17

New health care plans that combine employer-sponsored, a high deductible with lower premium options